Surgical method for endoscopic RYGBP ostomy revision

Abstract

A surgical method for restricting the size of a RYGBP patient's gastric outlet or “ostomy” by tightening an ostomy margin using existing in-market equipment to create banded tissue segments around the ostomy margin.

1 . An endoscopic surgical procedure for restricting flow through the ostomy of a RYGBP patient comprising the following steps:
 1. Sedating the patient with MAC anesthesia;   2. Performing a routine esophagogastroduodenoscopy (EGD) using an endoscope/gastroscope with a tube/channel;   3. Applying cautery circumferentially around an ostomy margin;   4. Passing an endoscopic tissue grasping device through the tube/channel, a distal end of such endoscopic tissue grasping device comprising forceps/graspers then grasping a tissue segment of the ostomy margin with a turning motion of said endoscopic tissue grasping device and retracting such device, thereby retracting the grasped tissue segment into the tube/channel of the endoscope/gastroscope;   5. Deploying a gastroscopic banding device, engaging the retracted tissue segment of the ostomy margin with a distal end of the gastroscopic banding device, then deploying a band to create a banded tissue area   6. Retracting, disengaging and withdrawing the endoscopic grasping device;   7. Repeating steps 4 and 5 to create multiple banded tissue segments around the ostomy orifice; and   8. Withdrawing the endoscope, thus terminating the procedure.   
     
     
         2 . The endoscopic surgical procedure of  claim 2 , wherein the distal end of the grasping device comprises forceps/graspers embodied as a screw mechanism. 
     
     
         3 . The endoscopic surgical procedure of  claim 1 , wherein the turning motion of the tissue grasping device of step 4 comprises three turns and the unscrewing motion of step 5 also comprises three turns. 
     
     
         4 . The endoscopic surgical procedure of  claim 1 , wherein the endoscopic tissue grasping device grasps a tissue segment of 1-2 cm in length and pulls the tissue segment into the distal end of the banding device 
     
     
         5 . The endoscopic surgical procedure of  claim 1 , wherein the distal end of the gastroscopic banding device comprises a hollow piece that engages the tissue segment by overlaying the tissue segment. 
     
     
         6 . The endoscopic surgical procedure of  claim 1 , wherein the banding process of steps 4 and 5 is repeated four times, one for each quadrant around the ostomy orifice. 
     
     
         7 . The endoscopic surgical procedure of  claim 1 , further comprising: 
     
     
         9 . Reintroducing endoscope to examine G-J anastomosis post therapy. 
     
     
         8 . The endoscopic surgical procedure of  claim 1 , wherein the cautery of step 3 is either BiCap or direct current cautery.